$190.60
Both concern closed treatment of a great toe fracture. Choose 28490 when treatment proceeds without manipulation and 28495 when the clinician manipulates the fracture.
On this page
CMS RVU26D · Effective 2026-10-01
28490 Toe fracture care Medicare reimbursement rates in Arizona
Reports closed treatment of a great toe fracture managed without manipulation, such as a stable fracture treated with immobilization and follow-up. Compare 28490 office and facility rates across CMS payment localities in Arizona.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 28490 in Arizona?
Arizona has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$154.27
1 of 1 localities have a supported rate.
Payment area: Arizona
One mapped payment locality.
Facility setting
$128.71
1 of 1 localities have a supported rate.
Payment area: Arizona
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Fracture care
About 28490: Closed treatment of great toe fracture
Reports closed treatment of a great toe fracture managed without manipulation, such as a stable fracture treated with immobilization and follow-up.
This code represents closed treatment of a great toe fracture when the treating clinician manages the fracture without manipulating it to change alignment. It commonly describes care for a stable fracture managed with measures such as buddy taping, a protective shoe, splinting, or casting. Orthopedic surgeons, podiatrists, and other clinicians who assume responsibility for fracture treatment may report it in an office, emergency, or other appropriate setting. A visit that only evaluates the injury before the patient is referred elsewhere is not the same as assuming fracture care.
Document the great toe fracture, the decision to treat it without manipulation, and the treatment plan. CMS assigns a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included. When multiple procedures are performed in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% reduction. For bilateral treatment, modifier 50 is paid at 150%. Assistant-at-surgery services are not paid; co-surgeons and team surgery are not permitted.
CMS billing rules for 28490
- Global period
- Major surgery with a 90-day global period: the day-before preoperative visit and 90 days of related postoperative care are included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral procedure with modifier 50 is paid at 150%.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.14 · 24%
- Practice expense (office) RVU3.44 · 72%
- Malpractice RVU0.17 · 4%
4.8K
Medicare services in 2024 · #1892 by national volume
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
28490 compared with similar codes
Office rates for Arizona, from the same CMS release.
$532.06
28496 involves percutaneous skeletal fixation with manipulation; 28490 is closed treatment without manipulation or percutaneous fixation.
$127.49
28510 is for a fracture of a toe other than the great toe treated without manipulation. Use 28490 for the great toe.
$230.75
28470 concerns closed treatment without manipulation of a metatarsal fracture. 28490 is for a fracture of the great toe.
Compare 28490 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Arizona →
Office / nonfacility
$154.27
Facility
$128.71
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 28490 in Arizona.
PPRRVU2026_Oct_nonQPP.csv
3,216
- Code
- 28490
- Physician work
- 1.14
- Practice expense
- 3.44
- Malpractice
- 0.17
GPCI2026.csv
6
- Locality
- Arizona
- Physician work
- 1.000
- Practice expense
- 0.969
- Malpractice
- 0.856
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.14 | × 1.000 | 1.1400 |
| Practice expense | 3.44 | × 0.969 | 3.3334 |
| Malpractice | 0.17 | × 0.856 | 0.1455 |
| Total RVUs | 4.6189 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Arizona$154.27
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.14 | 1 |
| Practice expense | 3.44 | 0.969 |
| Malpractice | 0.17 | 0.856 |
(1.14 × 1 + 3.44 × 0.969 + 0.17 × 0.856) × $33.4009 = $154.27
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.14 | 1 |
| Practice expense | 2.65 | 0.969 |
| Malpractice | 0.17 | 0.856 |
(1.14 × 1 + 2.65 × 0.969 + 0.17 × 0.856) × $33.4009 = $128.71
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
28490 billing questions
How is 28490 distinguished from 28495?
Use 28490 when the great toe fracture is treated without manipulation. When the clinician manipulates the fracture to alter alignment, consider 28495 instead.
When is 28496 considered instead?
28496 describes percutaneous skeletal fixation of a great toe fracture with manipulation. It is not the code for closed treatment without manipulation.
Does routine fracture follow-up fall within this code's global period?
CMS assigns 28490 a 90-day global period. The day-before preoperative visit and 90 days of related postoperative care are included.
How is treatment of both great toes handled?
CMS identifies this as a bilateral procedure; modifier 50 is paid at 150%. Document treatment of both sides.
Can an assistant, co-surgeon, or surgical team be paid for this service?
CMS applies a statutory restriction to assistant-at-surgery payment. Co-surgeons and team surgery are not permitted for this code.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
3,21328475,,Cltx metatarsal fx w/mnpj ea,A,,2.93,4.94,,3.40,,0.39,8.26,6.72,0,090,0.10,0.69,0.21,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21428476,,Prq skel fix metar fx w/mnpj,A,,3.51,7.55,NA,7.55,,0.55,11.61,11.61,0,090,0.10,0.69,0.21,2,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21528485,,Optx metatarsal fx each,A,,7.25,7.96,NA,7.96,,1.02,16.23,16.23,0,090,0.10,0.69,0.21,2,0,1,1,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21628490,,Treat big toe fracture,A,,1.14,3.44,,2.65,,0.17,4.75,3.96,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21728495,,Treat big toe fracture,A,,1.64,4.02,,2.78,,0.20,5.86,4.62,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21828496,,Treat big toe fracture,A,,2.42,13.50,,5.49,,0.50,16.42,8.41,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3,21928505,,Treat big toe fracture,A,,7.25,11.81,,5.89,,0.95,20.01,14.09,0,090,0.10,0.69,0.21,2,1,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3Medicare Administrative Contractor (MAC),State,Locality Number,Locality Name,2026 PW GPCI (with 1.0 Floor)***,2026 PE GPCI,2026 MP GPCI
410112,AL,00,ALABAMA,1.000,0.875,0.566
502102,AK,01,ALASKA*,1.500,1.065,0.551
603102,AZ,00,ARIZONA,1.000,0.969,0.856
707102,AR,13,ARKANSAS,1.000,0.859,0.515
801112,CA,54,BAKERSFIELD,1.019,1.096,0.609
901112,CA,55,CHICO,1.017,1.096,0.536